BACKGROUND Cancer-related fatigue (CRF) is one of the most distressing symptoms experienced by patients. There is no gold standard treatment, although multiple drugs have been tested with little evidence of efficacy. Randomised controlled trials (RCTs) of these drugs have commented on the existence or size of the placebo response (PR). The objective of this systematic review was to establish the magnitude of the PR in RCTs of drugs to relieve CRF and to identify contributing factors. METHOD RCTs were included in which the objective was to treat CRF. A meta-analysis was conducted using the standardised mean change (SMC) between baseline and final measurement in the placebo group. To explore factors that may be associated with the PR (eg, population or drug), a meta-regression was undertaken. Risk of bias was assessed using the revised Cochrane tool. RESULTS From 3916 citations, 30 relevant RCTs were identified. All had limitations that increased their risk of bias. The pooled SMC in reduction in fatigue status in placebo groups was -0.23 (95% confidence intervals -0.42 to -0.04). None of the variables analysed in the meta-regression were statistically significant related to PR. CONCLUSION There is some evidence, based on trials with small samples, that the PR in trials testing drugs for CRF is non-trivial in size and statistically significant. We recommend that researchers planning drug studies in CRF should consider implementing alternative trial designs to better account for PR and decrease impact on the study results. https://www.selleckchem.com/products/MK-1775.html © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.OBJECTIVE To elucidate the relationships between age, return to level I sport (RTS) within the first postoperative year, passing RTS criteria and second anterior cruciate ligament (ACL) injury. METHODS In a prospective cohort study, 213 athletes were followed for 2 years after ACL reconstruction to record second ACL injuries. Independent variables were age, passing RTS criteria and level I RTS within the first postoperative year (vs later or no RTS). We defined passing RTS criteria as ?90?on the Knee Outcome Survey - Activities of Daily Living Scale, global rating scale of function and quadriceps strength/hop test symmetry. RESULTS The follow-up rate was &gt;87%?for all outcomes. In multivariable analysis, level I RTS within the first postoperative year and passing RTS criteria were highly associated with second ACL injury (level I RTS HR 6.0 (95% CI 1.6 to 22.6), pass RTS criteria HR 0.08 (95% CI 0.01 to 0.6)), while age was not (age HR 0.96 (95% CI 0.89 to 1.04)). Athletes less then 25?years had higher level I RTS rates in the first postoperative year (60.4%) than older athletes (28.0%). Of those who returned to level I sport in the first postoperative year, 38.1% of younger and 59.1% of older athletes passed RTS criteria. CONCLUSION High rates of second ACL injury in young athletes may be driven by a mismatch between RTS rates and functional readiness to RTS. Passing RTS criteria was independently associated with a lower second ACL rate. Allowing more time prior to RTS, and improving rehabilitation and RTS support, may reduce second ACL injury rates in young athletes with ACL reconstruction. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND Increases in patients' length of stay (LOS) in the emergency department (ED) have led to overcrowding. OBJECTIVES In this study, the implementation of blood sampling during triage in lower priority level patients was assessed as a possible means to reduce LOS. METHODS A retrospective study was performed from January 2018 to January 2019. Lower priority level patients who required blood sampling for further diagnosis were considered. Patients who underwent blood sampling during triage evaluation were compared with those who underwent blood sampling after a physician's initial evaluation. RESULTS During the study period, 15,596 patients were enrolled. LOS was shorter in patients who underwent triage blood sampling, presenting a median value of 154&nbsp;min in comparison with the 172&nbsp;min recorded in the control group (p&nbsp; less then &nbsp;0.001). Using a propensity score-matching to control the two groups' differences, LOS remained lower in the triage-sampling group (151 vs. 175&nbsp;min; p&nbsp; less then &nbsp;0.001). In the adjusted multivariate model, triage blood sampling was found to be an independent factor for a decrease in the LOS, with standardized coefficient β&nbsp;=&nbsp;0.857 (0.822-0.894; p&nbsp; less then &nbsp;0.001). CONCLUSIONS Performing blood sampling during nurse triage can decrease LOS in ED and also reduce ED permanence after a physician's initial evaluation. BACKGROUND Increasing emergency department (ED) visits per capita, combined with an aging population and ongoing budgetary constraints in Canada's health care system necessitate continuous improvements to ensure that patients remain safe and continue to receive high quality care. Addressing ED nursing job satisfaction is a cost-effective way of improving safety and quality of hospital care. METHODS A scoping literature review was conducted to examine the breadth of job satisfaction literature and identify the factors that specifically influence the job satisfaction of ED nurses. RESULTS AND DISCUSSION A review of 161 journal articles revealed 34 articles fitting the inclusion criteria, which were included in the final analysis. There were ten predominant factors that allowed for workplace interventions, including six that did not achieve consensus. The ten factors are presented in the form of a practical model for implementation based on the Herzberg two-factor theory and the Maslow hierarchy of needs theory. CONCLUSION The model informs healthcare leaders how to pragmatically understand job satisfaction specific to ED nurses. This information in turn can be used to design interventions that increase job satisfaction while maintaining safety and quality of care. BACKGROUND Many ambulance personnel can withhold or terminate resuscitation on-scene, but these decisions are emotionally, ethically and cognitively challenging. Although there is a wealth of research examining training and performance of life-saving resuscitation efforts, there is little published research examining how ambulance personnel are prepared and supported for situations where resuscitation is unsuccessful, unwanted or unwarranted. AIM To identify and describe existing preparation and support mechanisms for ambulance personnel enacting decisions to terminate resuscitation and manage patient death in the field. METHOD Focus groups were held with senior ambulance personnel working in clinical education and peer support roles. RESULTS Participants believed professional and personal exposure to death and dying and positive social modelling by mentors were essential preparation for ambulance personnel terminating resuscitation and managing patient death. Ambulance personnel responded to patient death idiosyncratically.